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LDL Cholesterol Subfraction Testing of Limited Value

Authors conclude that routine use of low-density lipoprotein subfraction testing to estimate cardiovascular risk is premature

TUESDAY, April 7 (HealthDay News) -- Measures of low-density lipoprotein (LDL) subfractions -- such as small dense LDL particles, medium LDL particles or large LDL particles -- do not add incremental benefit to traditional risk factor assessment for cardiovascular disease, according to a report published in the April 7 issue of the Annals of Internal Medicine.

Stanley Ip, M.D., of Tufts Medical Center in Boston, and colleagues conducted a systematic review of 24 studies that reported an association between LDL subfractions and incidence or severity of cardiovascular disease, including 10 studies that used nuclear magnetic resonance.

The researchers found that all 24 studies showed that an increased risk for cardiovascular disease was consistently associated with a higher LDL particle number, which was independent of other lipid measurements. They also found that an increased risk of cardiovascular disease was generally not associated with LDL subfractions after adjustment for cholesterol concentrations.

"Strong observational data suggested a positive association between plasma concentrations of homocysteine and cardiovascular outcomes, but randomized trials of treatments that successfully decreased homocysteine concentrations did not result in statistically significant benefit on cardiovascular end points or total mortality," the authors conclude. "Thus, even if LDL subfraction testing proves to be associated with cardiovascular outcomes, the tests will be of clinical value only if treatments based on the results of the LDL subfraction testing prove to be beneficial."

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